Information Collection

Food Safety Behaviors and Consumer Education: Focus Group Research

IC 229872 under ICR 201801-0583-001 · OMB 0583-0173.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix B Mod Guide Set 1_post pilot.docx	Other-moderator guide questions
Appendix A English and Spanish Screener Set_updated_3_9_18.doc	Other-screening questionnaire
Appendix C Screener Set 2_updated_3_9_18.doc	Other-screening questionnaire 2
Appendix D Mod Guide Set 2_updated_3_9_18.docx	Other-moderator guide questions 2
Appendix G IRB Approval Form_9_25_17.pdf IRB Approval Form	IC Document
Appendix E English and Spanish Consent_Form_Set 1_updated_3_9_18.doc English and Spanish consent form	IC Document
Appendix F Consent_Form_Set 2_updated_3_9_18.doc Consent Form Set 2	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-moderator guide questions	Appendix B Mod Guide Set 1_post pilot.docx	No	Paper Only
Other-screening questionnaire	Appendix A English and Spanish Screener Set_updated_3_9_18.doc	No	Paper Only
Other-screening questionnaire 2	Appendix C Screener Set 2_updated_3_9_18.doc	No	Paper Only
Other-moderator guide questions 2	Appendix D Mod Guide Set 2_updated_3_9_18.docx	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,125

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,125	2,125
Annual IC Time Burden (Hours)	681	681
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
IRB Approval Form	Appendix G IRB Approval Form_9_25_17.pdf	01/26/2018
English and Spanish consent form	Appendix E English and Spanish Consent_Form_Set 1_updated_3_9_18.doc	03/12/2018
Consent Form Set 2	Appendix F Consent_Form_Set 2_updated_3_9_18.doc	03/12/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.